Unit of Endocrinology and Nutrition, Hospital General de Segovia, Segovia, Spain.
Int J Clin Pract. 2012 Oct;66(10):959-68. doi: 10.1111/j.1742-1241.2012.03000.x.
To evaluate whether administration of long-acting basal insulin analogue plus oral antidiabetic drugs (OADs) improves glycaemic control in type 2 diabetic patients with glycosylated haemoglobin (HbA1c) > 7% (53 mmol/mol) under premixed insulin therapy.
This is a multicentre, observational, retrospective study performed in type 2 diabetic patients switching from premixed insulin to long-acting basal insulin analogue plus OADs. Data on patients' medical history and assessments were retrieved from patients' medical charts prior to switching the treatment and 6 months thereafter.
A total of 131 evaluable patients were enrolled (mean age, 68.2 ± 9.4 years; female, 65.6%; mean diabetes duration, 12.7 ± 6.9 years; mean time on insulin therapy, 53.2 ± 41.9 months). Patients were receiving premixed insulin (once-daily, 4.7%; twice-daily, 85.0%; thrice-daily, 10.2%), 82.4% of whom in combination with OADs (metformin, 79.4%). After the treatment was switched, only 14.5% required intensification of treatment with additional preprandial insulin. HbA1c decreased -1.4% [mean ± SD, 8.4 ± 1.0% (68.7 ± 11.4 mmol/mol) vs. 7.0 ± 1.0% (53.6 ± 10.9 mmol/mol), p < 0.001] and the proportion of patients achieving HbA1c < 7% (53 mmol/mol) increased to 52.7% (p < 0.001). The percentage of patients with hypoglycaemia decreased (19.2% vs. 10.8%, p < 0.05; symptomatic, 17.6% vs. 4.6%, p < 0.01) and body weight diminished by -1.9 kg (mean ± SD, 78.5 ± 14.7 kg vs. 76.6 ± 13.9 kg, p < 0.05). Basal insulin plus OADs was considered more convenient and flexibly adapted to patients' life in 98.4% and 99.2% of patients, respectively. Additionally, 96.9% of patients reported being more satisfied and 96.9% would recommend it.
Switching the treatment from premixed insulin to long-acting basal insulin analogue plus OADs is a feasible and convenient approach to improve glycaemic control of type 2 diabetic patients poorly controlled with premixed insulin under routine clinical practice conditions.
评估在预混胰岛素治疗下糖化血红蛋白（HbA1c）＞7%（53mmol/mol）的 2 型糖尿病患者转为使用长效基础胰岛素类似物联合口服降糖药（OAD）治疗后，血糖控制是否得到改善。
这是一项多中心、观察性、回顾性研究，纳入了在预混胰岛素治疗下转换为长效基础胰岛素类似物联合 OAD 治疗的 2 型糖尿病患者。在转换治疗前和治疗后 6 个月，从患者的病历中检索患者的病史和评估数据。
共纳入 131 例可评估患者（平均年龄 68.2±9.4 岁；女性 65.6%；平均糖尿病病程 12.7±6.9 年；胰岛素治疗时间 53.2±41.9 个月）。患者接受预混胰岛素（每日 1 次 4.7%；每日 2 次 85.0%；每日 3 次 10.2%）治疗，其中 82.4%联合 OAD（二甲双胍 79.4%）治疗。治疗转换后，仅 14.5%需要用额外的餐时胰岛素来加强治疗。HbA1c 下降了 1.4%[平均±标准差，8.4±1.0%（68.7±11.4mmol/mol）与 7.0±1.0%（53.6±10.9mmol/mol），p＜0.001]，达到 HbA1c＜7%（53mmol/mol）的患者比例增加到 52.7%（p＜0.001）。低血糖的发生率降低（19.2%比 10.8%，p＜0.05；症状性 17.6%比 4.6%，p＜0.01），体重减轻了 1.9kg（平均±标准差，78.5±14.7kg 比 76.6±13.9kg，p＜0.05）。分别有 98.4%和 99.2%的患者认为基础胰岛素联合 OAD 更方便，且更能适应他们的生活。此外，96.9%的患者报告更满意，96.9%的患者会推荐这种治疗。
在常规临床实践条件下，对于预混胰岛素控制不佳的 2 型糖尿病患者，从预混胰岛素转换为长效基础胰岛素类似物联合 OAD 是一种可行且方便的改善血糖控制的方法。
